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MELANOMA MALIGNO, NEVUS GIGANTE PIGMENTADO E INVOLUCIÓN 
MALIGNANT MELANOMA, PIGMENTED CONGENITAL NEVUS AND
REGRESSION
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****** DERMAGIC-EXPRESS No.46 ******* 
****** 14 ABRIL DE 1.999 *********** 
14 APRIL 1.999
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EDITORIAL ESPAÑOL:
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Saludos amigos del DERMA-CYBER,,, el tema de hoy MELANOMA MALIGNO, NEVUS GIGANTE PIGMENTADO E INVOLUCIÓN.

Pueden realmente estos nevus experimentar regresión espontanea. ??? Revisé la literatura y encontré algunas referencias que apoyan estos comentarios. Espero que las disfruten.

En el attach 1 lamina ilustrativa de la referencia No.1.) Regresión espontánea de nevo pigmentado celular gigante congénito con melanoma maligno,, ...alguien diría por allí "aunque usted no lo crea..."


Saludos a TODOS !!!

PRÓXIMA EDICIÓN: LA D-PENICILAMINA , LO BUENO Y LO MALO.

Dr. José Lapenta R.,,,



EDITORIAL ENGLISH:
=====================
Greetings friends of the DERMA-CYBER, today's topic MALIGNANT MELANOMA, PIGMENTED CONGENITAL NEVUS AND REGRESSSION.

Really can these nevus to experience spontaneous regression. ???. Look for in the literature and I found some references that support these comments. I hope enjoy them. 

In the attach 1 illustrative sheet of the reference No.1.) Spontaneous regression of congenital giant cell pigmented nevus with malignant melanoma,,, ...somebody would say... believe it..or not." 

Greetings to ALL!!! 

NEXT EDITION: THE D-PENICILLAMINE, THE GOOD AND THE BAD.


Greetings to ALL, !!


Dr. José Lapenta R.,,

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DERMAGIC/EXPRESS(46)
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MELANOMA MALIGNO, NEVUS PIGMENTADO CONGENITO  E INVOLUCION /
MELANOMA MALIGNANT, PIGMENTED CONGENITAL NEVUS AND REGRESSION
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1.) Spontaneous regression of congenital giant cell pigmented nevus with malignant melanoma (attach file melano.gif)
2.) Pigmentary regression in a giant nevocellular nevus: a case report and a review of the subject. 
3.) Spontaneous resolution of a giant congenital melanocytic nevus. 
4.) Regressing malignant melanoma. 
5.) Spontaneously regressing malignant melanoma with unusual histological features. 
6.) Metastatic malignant melanoma with spontaneous and complete regression of the primary lesion. Case report and review of the literature. 
7.) The many faces of completely regressed malignant melanoma. 
8.) Immune response against human primary malignant melanoma: a distinct cytokine mRNA profile associated with spontaneous regression. 
9.) Double choroidal malignant melanoma in an eye with apparent clinical regression. 
10.) Effect of IFN-alpha on tumor-infiltrating mononuclear cells and regressive changes in metastatic malignant melanoma. 
11.) Regression of cardiac involvement by malignant melanoma following lomustine chemotherapy. 
12.) Malignant melanoma risk factors by anatomic site: a case-control study and polychotomous logistic regression analysis. 
13.) Clonal T cell responses in tumor infiltrating lymphocytes from both regressive and progressive regions of primary human malignant melanoma. 
13-A) Complete regression of primary cutaneous malignant melanoma. 
14.) Prognostic factors in thin cutaneous malignant melanoma. 
15.) Histologic regression in malignant melanoma: An interobserver concordance study
16.) Histological regression in malignant melanoma: recognition, incidence and significance (Meeting abstract).
17.) Complete spontaneous regression of cutaneous primary malignant melanoma
18.) Lymph nodes with metastatic melanoma of unknown primary site
19.) Malignant melanoma of the parotid gland
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1.) Spontaneous regression of congenital giant cell pigmented nevus with malignant melanoma
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J.-I. Hasegawa, N. Maeda, T. Kanzaki, N. Mizuno
Departments of Dermatology, Nagoya City University Medical School, Nagoya, Japan

case report:

A 13-year-old Japanese girí was seen with a giant pigmented nevus on her right temple, scalp, neck, upper trunk and right arm, present already at birth (Fig 1). This pigmented nevus gradually faded away by casting off black crusts or scales from the surface over a time span of 13 years (Fig. 2). The black lesion totally flattened and became normal in color leaving several small neurofibroma-like nodules (Fig. 2). At the age of 6 years a nodular black pedunculated tumor 3 cm in diameter de-veloped on her upper back. This proved to be a malignant melanoma histologically. The tumor was excised locally. A recur-rence or metastasis has not been observed since then for 7 years.

Histological findings at birth. 

Two types of histology were observed. One was a compound nevus with irregular acanthosis and hyperkeratosis, and the other a com-pound nevus with neurofibroma-like der-mis. Both of them showed strong junctional activity and casting off phenomenon (transepidermal elimination). No cellular atypia was observed.


Histological findings at 6 years of age

(malignant melanoma and nevus). 
The malignant melanoma was composed of 2 celí types i. e. spindle and epithelioid celís. The nevus resembled a neurofibroma; there was no junction~ activity whatsoever. There are 4 possibilities in the spontaneous regression of nevocellular nevi and malignant melanoma. These are

I) Sutton's phenomenon (4),

II) transepi-46 dermal elimination (2),

III) neurofibromatous and

IV) fatty degenerations.

Fig. 1. Clinical feature at 4 days oid.
Fig. 2. Giant pigmented nevus regressed at 6 years oíd. (see the attach)


The spontaneous regression of congeni-tal pigmented nevus of our case is believed to be caused by the transepidermal elimination of nevus celis as reported by Kan-zaki et al. (2).

Many black crusts or scales were sbed from the lesion resulting in clearing of the nevus, as the parents reported. This was supported by the histological examination, which revealed the nevus celís being eliminated from the epidermis. The nevus celís in the dermis were replaced by neuro-fibromatous celis in the deeper dermis.

To our best knowledge, tliis is tbe first case which showed complete spontaneous regression of a congenital giant pigmented nevus.

References
1. Copeman PWM, et al. Br J Dermatol 1973; ~ 127
2. Kanzaki T, et al. The l2th International Pigment Ceil Conference. 19~3; p 1(13

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2.) Pigmentary regression in a giant nevocellular nevus: a case report and a review of the subject. 
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ARTICLE SOURCE: Pediatr Dermatol (United States), Aug 1988, 5(3) p178-83 
AUTHOR(S): Zack LD; Stegmeier O; Solomon LM 
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (42 references); REVIEW OF REPORTED CASES 

ABSTRACT: A giant congenital nevocytic nevus (CNN) on the trunk was followed in a patient from age three months to 23-years-old. During that time the nevus underwent pigmentary regression leaving 2-3 mm lentigines without any evidence of vitiligo or halo formation around the giant CNN. Histopathologically, nevus cells remained in the dermis. 

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3.) Spontaneous resolution of a giant congenital melanocytic nevus. 
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ARTICLE SOURCE: Pediatr Dermatol (United States), Aug 1988, 5(3) p170-2 
AUTHOR(S): Hogan DJ; Murphy F; Bremner RM 
PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: This is the second report of a case of spontaneous resolution of a giant congenital melanocytic nevus, which was documented both by photographs and skin biopsies. Cases of spontaneous resolution of these lesions may represent a vigorous host response against an aberrant clone of melanocytes. 

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4.) Regressing malignant melanoma. 
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Author 
Grafton WD 
Address 
Louisiana State University School of Medicine, Shreveport 71130. 
Source 
J La State Med Soc, 146(12):535-9 1994 Dec 

Abstract 

Malignant melanoma may undergo spontaneous regression. This phenomenon may cause difficulty in clinical or pathologic diagnosis. The cases reported in the literature as complete spontaneous regression of primary malignant melanomas have been diagnosed only in retrospect, after the patient presented with metastatic malignant melanoma. Two cases of malignant melanoma with partial regression are reported. In these cases the areas of complete regression cannot be recognized as malignant melanoma. The definitive diagnosis of malignant melanoma can be made only in the areas with at least two of three characteristic features of melanoma:

(1) melanocytic cells with atypical nuclei and prominent nucleoli,

(2) mitoses in melanocytic cells, and

(3) invasion of the epidermis by atypical melanocytic cells.

Clinical features suggesting regressing malignant melanoma include changes in color, especially areas of depigmentation, variations in color in different areas of a pigmented mole, and decrease in size of a mole. Histopathologic features of regression include loss of melanin pigment from the epidermis, melanophages in the dermis, telangiectasia of capillaries in the dermis, and lymphocytic infiltration in the dermis in a band-like or perivascular pattern. These histologic findings may also be found in inflammatory lesions such as lichen planus and in regressing benign melanocytic nevi. 

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5.) Spontaneously regressing malignant melanoma with unusual histological features. 
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Author 
Tamura A; Ishikawa O; Miyachi Y 
Address 
Department of Dermatology, Gunma University School of Medicine, Japan. 
Source 
Acta Derm Venereol, 74(6):451-3 1994 Nov 

Abstract 

An 85-year-old man with spontaneously regressing primary malignant melanoma is reported. Histological features were considered to be compatible with those of spontaneously regressing malignant melanoma, except that many multinucleated giant cells were observed replacing typical melanoma cells. 

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6.) Metastatic malignant melanoma with spontaneous and complete regression of the primary lesion. Case report and review of the literature. 
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Author 
Shai A; Avinoach I; Sagi A 
Address 
Department of Plastic and Reconstructive Surgery, Soroka University Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 
Source 
J Dermatol Surg Oncol, 20(5):342-5 1994 May 

Abstract 

BACKGROUND. Spontaneous regression of malignant melanoma is characterized by a partial or complete disappearance of the neoplasm. Partial regression of melanoma has been documented in large series, but complete regression is reported as occurring only sporadically.

OBJECTIVE. To describe a case of metastatic malignant melanoma where the primary lesion underwent spontaneous and complete regression and to review the literature pertaining to regression of melanoma.

METHODS. The patient was examined clinically. Wide excision of the skin with the lesion was performed as well as left inguinal lymph node dissection.

 RESULTS. Histologic examination of the lesion revealed complete regression of malignant melanoma. Examination of the lymph node dissected from the adjacent inguinal area revealed matastatic melanoma.

CONCLUSIONS. Greater attention should be devoted to identification of regression in melanoma, clinically and histologically, evaluating the prognostic implications which regression might indicate. 

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7.) The many faces of completely regressed malignant melanoma. 
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Author 
Barr RJ 
Address 
University of California, Irvine, USA. 
Source 
Pathology (Phila), 2(2):359-70 1994 

Abstract 

The prognostic significance of clinical and histologic regression of malignant melanoma is highly controversial. Although small foci of regression in evolving malignant melanomas seem to have little or no effect on morbidity and mortality, extensive regression in larger, fully evolved lesions may be associated with poor prognosis. This chapter emphasizes the histologic features of regression and the patterns that are responsible for diagnostic pitfalls. 

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8.) Immune response against human primary malignant melanoma: a distinct cytokine mRNA profile associated with spontaneous regression. 
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Author 
Wagner SN; Schultewolter T; Wagner C; Briedigkeit L; Becker JC; Kwasnicka HM; Goos M 
Address 
Department of Dermatology, University of Essen, Germany. 
Source 
Lab Invest, 78(5):541-50 1998 May 

Abstract 

Spontaneous regression of melanoma lesions is thought to be the result of an efficient immune response against melanoma cells in vivo. The outcome of immune responses is critically influenced by a complex network of interacting cytokines present in the local microenvironment.

Analysis of cytokine gene transcription in melanoma lesions exhibiting or lacking a sufficient anti-tumor immune response thus may help to define cytokines or cytokine combinations critical to the development of this immune response. In the present study, we have investigated an extended panel of cytokine and cytokine receptor genes by reverse transcription-PCR and in situ hybridization in regressive and progressive primary human cutaneous melanoma samples.

Whereas the presence of a lymphocyte infiltrate in tissue samples was associated with a TH1 cytokine mRNA profile (TNF-alpha, INF-gamma, IL12p35, IL12p40, IL2Rbeta, and IL2Rgamma), clinically and histologically regressive samples exhibited additionally increased transcript levels for GM-CSF, IL2, and IL15. mRNAs of TH2 cytokines IL4 and IL5 were detected only in a minor portion of progressive melanoma samples and regressive melanoma lesions.

These results were further supported by comparison of progressive with regressive regions in three melanoma samples. Again, regressive regions contained higher transcript levels for GM-CSF, IL2, and IL15. In comparison to cutaneous metastatic melanoma lesions, regressive melanomas also overexpressed the same cytokine mRNA profile. These results provide evidence for an association of spontaneous regression with increased transcript levels for the cytokine combination GM-CSF, IL2, and IL15 in malignant melanoma.

This cytokine combination could be relevant for experimental anti-tumor immune response studies and for immunotherapeutic and gene transfer studies in the treatment of melanoma patients. 

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9.) Double choroidal malignant melanoma in an eye with apparent clinical regression. 
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Author 
Holck DE; Dutton JJ; Pendergast SD; Klintworth GK 
Address 
Department of Ophthalmology, Wilford Hall Medical Center, San Antonio, Texas 78236, USA. 
Source 
Surv Ophthalmol, 42(5):441-8 1998 Mar-Apr 

Abstract 

Multicentric melanomas in the same eye are rare, with few cases substantiated by histology and serial sectioning. We report a patient with two documented choroidal malignant melanomas in one eye.

The initial tumor spontaneously decreased in size for over 2 years before a second tumor appeared in a noncontiguous location in the same eye. After enucleation, serial sections showed that the two lesions were independent choroidal melanomas. We review the literature regarding multiple, independent intraocular choroidal malignant melanomas. 

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10.) Effect of IFN-alpha on tumor-infiltrating mononuclear cells and regressive changes in metastatic malignant melanoma. 
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Author 
H akansson A; Gustafsson B; Krysander L; H akansson L 
Address 
Department of Oncology, University Hospital, Link¨oping, Sweden. 
Source 
J Interferon Cytokine Res, 18(1):33-9 1998 Jan 

Abstract 

Interferon-alpha (INF-alpha) has a documented activity against metastatic melanoma. To what extent an antiproliferative effect or tumor cell modulation or immunomodulation contributes to this antitumor effect is still uncertain.

The role of immune mechanisms in the control of malignant melanoma is suggested by several studies. Therefore, this investigation used monoclonal antibodies, anti-CD4, anti-CD8, and anti-CD11c, to study the occurrence and distribution of tumor-infiltrating mononuclear cells in 10 untreated and 26 IFN-alpha-treated patients with regional metastatic malignant melanoma. IFN-alpha was given for 1-3 weeks before resection of the metastases. The infiltration of mononuclear cells in the stroma and close to tumor cells was studied.

The duration of IFN-alpha treatment was found to be of importance for the immunomodulatory effect. In patients treated for < or = 1 week, tumor-infiltrating mononuclear cells were still mainly localized in the stroma, similar to the situation in untreated patients.

The differences in CD4+ cells close to the tumor cells, comparing untreated patients and patients with various durations of IFN-alpha treatment, were highly significant (p = 0.009). Thus, IFN-alpha treatment resulted in recruitment of CD4+ cells close to the tumor cells. IFN-alpha had only a weak effect on the recruitment of CD8+ and CD11c+ mononuclear cells close to the tumor cells.

Regressive changes in metastases were also analyzed and correlated to duration of treatment. Some of the criteria used for histopathologic regression in primary melanoma (distorted histologic architecture, low tumor cell density, and fibrosis) were applied to analyze the effect of IFN-alpha in metastatic melanoma.

The tumor cell density was found to be significantly reduced in metastases with marked tumor regression compared with metastases with no, or only minor, regressive changes (p < 0.005). A chi-square analysis for trend, comparing untreated patients and patients with various durations of IFN-alpha treatment, showed that regressive changes of the tumor increased significantly during IFN-alpha treatment (p = 0.02). 

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11.) Regression of cardiac involvement by malignant melanoma following lomustine chemotherapy. 
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Author 
Carpenter MR; Vassallo M; Peat IM; Scriven AJ 
Address 
Department of Cardiology, Leicester General Hospital, UK. 
Source 
Postgrad Med J, 73(863):571-2 1997 Sep 

Abstract 

Cardiac involvement by malignant melanoma is usually a premorbid event. We present a case of presumed cardiac involvement by malignant melanoma with regression following chemotherapy as demonstrated by transoesophageal echocardiography. 

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12.) Malignant melanoma risk factors by anatomic site: a case-control study and polychotomous logistic regression analysis. 
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Author 
Chen YT; Dubrow R; Holford TR; Zheng T; Barnhill RL; Fine J; Berwick M 
Address 
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA. 
Source 
Int J Cancer, 67(5):636-43 1996 Sep 4 

Abstract 

This population-based case-control study systematically examined reported malignant melanoma risk factors by anatomic site. Study subjects consisted of 548 invasive melanoma cases diagnosed in Connecticut during 1987-1989 and 494 randomly selected controls. Multivariate polychotomous logistic regression was used to determine whether risk factors differed across anatomic sites.

Risk factors examined included demographic and pigmentary characteristics, sun exposure-related factors, anatomic site-specific sunburn, recreational water activity clothing habits and number of nevi. A pattern of site-specificity was observed for sunburn.

A history of sunburn at an anatomic site was specifically related to the development of malignant melanoma at that site more so than at other sites. This site-specificity was consistent with a direct role for intense, intermittent sun exposure in the development of melanoma. Age and gender were the only risk factors that differed significantly in effect across anatomic sites.

The age difference was explained by differences in histologic subtype across sites. The gender difference could not be explained by sex differences in anatomic site-specific sunburns or in recreational water activity clothing habits. Alternative explanations include sex differences in behavioral patterns of sun exposure that we did not measure and as yet unelucidated differences in susceptibility to melanoma according to sex and anatomic site. 

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13.) Clonal T cell responses in tumor infiltrating lymphocytes from both regressive and progressive regions of primary human malignant melanoma. 
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Author 
thor Straten P; Becker JC; Seremet T; Br¨ocker EB; Zeuthen J 
Address 
Department of Tumor Cell Biology, Division of Cancer Biology, Danish Cancer Society, Copenhagen, Denmark. 
Source 
J Clin Invest, 98(2):279-84 1996 Jul 15 

Abstract 

The T cell receptor (TCR) BV variable (V) gene repertoire of tumor infiltrating lymphocytes (TIL) found in progressive and regressive regions of the same primary human melanomas were characterized by reverse transcription coupled polymerase chain reaction (RT-PCR).

After surgery, the tumors were divided into different parts which were judged as regressive or progressive regions by visual inspection. Subsequently this diagnosis was confirmed by histology.

From a total of four primary melanomas analyzed, 2 were drawn to be HLA-A2+. Only relatively few BV-gene families were expressed at significant levels in each of the samples.

Comparison of the BV-expression in regressive versus progressive regions of the same tumor revealed major differences in all cases examined. Direct sequencing of RT-PCR products indicated that highly expressed BV-gene families were of clonal origin in both the regressive and progressive regions.

Together, these data strongly suggest the occurrence of clonal T cell responses in both regressive and progressive areas of the same primary tumor. The differences in expression of certain BV-genes may correlate with the functional activity of certain populations of tumor-infiltrating T cells. 

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13-A) Complete regression of primary cutaneous malignant melanoma. 
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Menzies SW; McCarthy WH  Address 
Department of Surgery, Sydney Melanoma Unit, University of Sydney, Camperdown, Australia. 
Source 
Arch Surg, 132(5):553-6 1997 May 

Abstract 


While partial spontaneous histopathological regression is a common finding in invasive primary melanoma, proven complete regression is rare, with only 33 cases having been documented. None of the patients in these reported cases had a biopsy specimen taken from the original lesion, which would unequivocally prove the diagnosis of complete regressing melanoma.

Over 4 years, we saw a 62-year-old white man who refused treatment of a biopsy specimen-proved superficial spreading melanoma (Breslow thickness, 0.7 mm) that eventually regressed completely. A biopsy specimen confirmed complete histopathological regression. There was no clinical evidence of regional or distant metastases throughout the 4 years.

To our knowledge, this is the first documented case of a biopsy specimen-proved primary melanoma completely regressing. We present sequential photographic documentation and review the literature about this phenomenon. While the prevalence of such an event is unknown, evidence is presented that it may be more common than previously thought. 

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14.) Prognostic factors in thin cutaneous malignant melanoma. 
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Author 
M ansson-Brahme E; Carstensen J; Erhardt K; Lagerl¨of B; Ringborg U; Rutqvist LE 
Address 
Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden. 
Source 
Cancer, 73(9):2324-32 1994 May 1 

Abstract 

BACKGROUND. Thin melanomas can metastasize and be lethal. The predictive importance of tumor thickness in thin melanomas and the specific features identifying the patients at risk have not been investigated fully.

METHODS. Prognostic factors were analyzed in 585 patients with clinical Stage I invasive cutaneous malignant melanoma with a thickness of less than or equal to 0.8 mm. The patients were included in a population-based cancer registry in Stockholm county during 1976-1987. They constituted about 64% of all patients with thin melanomas who were diagnosed in the region during the study period. Information was available on age, sex, anatomic site of the tumor, histologic type of melanoma, level of invasion, tumor thickness, and tumor regression. In a Cox regression analysis, the prognostic importance of each factor was studied. By a case-control technique with individual matching for the identified independent predictors of recurrence, the additional prognostic information given by type and grade of inflammatory response, presence of vertical growth phase, mitotic rate/mm2, and histologic ulceration of the tumor was assessed.

RESULTS. After a median follow-up time of 50 months, recurrent disease developed in 26 patients (4%). There was no difference in recurrence rate between patients treated with narrow (1-2 cm) or wide (5 cm) excision. Anatomic site, tumor thickness, level of invasion, and tumor regression were found to be independent prognostic factors in the multivariate analysis. In the case-control study, only grade of inflammatory reaction added significant prognostic information. No subgroup could be identified that was without risk of recurrent disease.

CONCLUSIONS. Thin melanomas do not seem to constitute a separate form of melanoma, but compose one end of a continuous spectrum of biologic behavior. 

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15.) Histologic regression in malignant melanoma: An interobserver concordance study
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AU: Kang-S; Barnhill-RL; Mihm-MC Jr; Sober-AJ
SO: J-Cutan-Pathol. 20(2):126-9 1993
PY: 1993
PT: JOURNAL-ARTICLE

AB-A: Histologic evidence for regression as a prognostic indicator in melanoma has shown conflicting results. To assess if melanoma regression is a consistently identifiable histologic feature, an interobserver concordance study was undertaken.

Fifty histologic slides of melanoma with Breslow thickness of 1 mm or less were non-randomly selected from the Massachusetts General Hospital Melanoma Registry. The selection was in favor of those with regression present in 44 of 50 slides (88%).

Two dermatopathologists working independently evaluated a 2 mm wide bracketed area in each tissue section and then the remainder of the non-bracketed tissue section for regression. Before and after each slide review, the evaluators were required to read criteria for early, intermediate, and late regression explicitly outlined.

The overall concordance rate for the presence and absence of regression was 96% (48/50) in the bracketed area and 90% for the outside area. When the group with regression was subdivided into three stages, interobserver agreement fell to 86% for the bracketed, and 66% for the outside area. In at least 30% of cases where regression was detected in the bracketed area, both reviewers observed two or more stages of regression in the remainder of tissue section.

Therefore, subdividing the process is impractical and unrealistic. Consistent histologic identification of regression in melanoma requires a simple and systematic approach which should be applied to future studies that include melanoma regression as a prognostic factor. (Abstract from CANCERLIT AND EMBASE)

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16.) Histological regression in malignant melanoma: recognition, incidence and significance (Meeting abstract).
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AU: Blessing-K; McLaren-KM
SO: J-Pathol. 167(Suppl):162A 1992
PY: 1992
PT: MEETING-ABSTRACT

AB-A: The phenomenon of tumor regression presents a potentially dramatic demonstration in favor of a role for host immunity. Although complete regression in melanoma is rare, partial regression is relatively common; however, there is a wide range of reported incidence, most of which can be explained by differences in criteria for definition of the process. The clinical significance of regression in melanoma also remains unresolved.

From the Department of Pathology in Aberdeen, 563 cases of primary melanoma (from a 20-yr period) were assessed for the presence of histological regression, in association with the thickness of the lesion, patient sex, anatomical location and clinical outcome.

The extent of lesional regression was assessed semiquantitatively. Regression was more commonly found in thin lesions, being seen in 46% of thin (less than 1.5 mm) lesions, 32% of intermediate (1.5-3.0 mm) lesions and 9% of thick (greater than 3.0 mm) lesions.

However, severe regression was only identified in 6.5% of thin lesions, 5.2% of intermediate lesions and 1.5% of thick melanomas. Regression was more common in superficial spreading melanomas and in lesions from the trunk and lower limb, with it being seen slightly more often in men. Clinical follow-up, although not of statistical significance, suggests that regression in thin lesions is a sinister histological feature, supporting results from other centers. (Abstract from CANCERLIT)

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17.) Complete spontaneous regression of cutaneous primary malignant melanoma
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AU: Bottger-D; Dowden-RV; Kay-PP
SO: PLAST-RECONSTR-SURG. 89/3 (548-553) 1992
PY: 1992
PT: Journal-Article

AB-A: Melanomas may first present as nodal metastasis. Most of these cases have a discernible primary source. A proportion of these, however, have no apparent primary.

A very few patients in this latter group actually have an identifiable primary source that regressed and disappeared. There is a set of stringent clinical and histologic criteria that must be met before a melanoma can be classified as complete spontaneous regression, and only 24 cases in the literature meet all these criteria.

This report reviews those cases and presents the first report to provide sequential photographic documentation of a complete spontaneous regression of a cutaneous malignant melanoma. It also gives a 10-year follow-up, the longest in the literature. (Abstract from EMBASE)

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18.) Lymph nodes with metastatic melanoma of unknown primary site
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AU: Nguyen-T; Avril-MF; Charpentier-P; Guillaume-C; Margulis-A; Prade-M
SO: Bull-Cancer-Paris. 79(3):291-6 1992
PY: 1992
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-MULTICASE

AB-A: Sixteen patients with clinical stage II melanoma of unknown primary site (regional lymph node metastasis) were followed up between 1978 and 1988. The 5-year survival rate was 47%. These results seem to parallel those for stage II disease with known primary tumor sites, as has been observed in other data from the literature.

The hypotheses put forward to explain such lesions are the spontaneous regression of the primary tumor, and the onset of primary malignant melanoma in the lymph nodes. (30 Refs) (Abstract from CANCERLIT AND EMBASE)

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19.) Malignant melanoma of the parotid gland
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AU: Roberts-C; Jayaramachandran-S
SO: Br-J-Clin-Pract. 46(3):217-8 1992
PY: 1992
PT: JOURNAL-ARTICLE

AB-A: We report a case which demonstrates pitfalls in the management of a parotid gland s and highlights behaviour of malignant melanoma that is not widely appreciated. The danger of assuming a benign histological diagnosis of such a mass and the subsequent delay of definitive surgery is demonstrated.

Metastases within the parotid gland are not uncommon, melanoma being one of the commonest sources. A search should always be made for a primary tumour in the head, neck and chest. This can be made exceptionally difficult by the uncommon phenomenon of spontaneous regression of the primary melanoma. (Abstract from CANCERLIT AND EMBASE)

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DATA-MÉDICOS/DERMAGIC-EXPRESS No (46) 14/04/99 DR. JOSÉ LAPENTA R. 
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